Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). This year’s report also shows greater participation from managed care organizations (MCOs) as a key trend.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

HIPAA Journal

FEBRUARY 14, 2023

Hackers gained access to Umass Memorial Health’s email environment between June 24, 2020 and January 7, 2021, as a result of responses to phishing emails. Claims may also be submitted for extraordinary losses up to a maximum of $5,000, which can include documented, unreimbursed losses to fraud and identity theft.

Fraud 115

Fraud Licensing Health Insurance HIPAA 115

HIPAA Journal

APRIL 15, 2022

A subset of individuals also had their Social Security numbers and/or driver’s license numbers exposed. SuperCare Health said unauthorized individuals had access to its network between July 23, 2021, to July 27, 2021, but did not disclose the nature of the cyberattack.

Electronic Medical Records 124

Electronic Medical Records HIPAA Health Insurance Fraud 124

HIPAA Journal

FEBRUARY 15, 2023

The medical device manufacturer Electromed has proposed a $850,000 settlement to resolve claims related to a June 2021 ransomware attack and data breach involving the protected health information of 47,200 individuals.

Ransomware 108

Ransomware Fraud Licensing Health Insurance 108

HIPAA Journal

NOVEMBER 16, 2022

Suspicious activity was detected within its email environment on December 16, 2021, passwords were changed to prevent further unauthorized access, and third-party cybersecurity experts were engaged to investigate the unauthorized activity. Notification letters were sent to affected individuals on October 31, 2022.

HIPAA 111

HIPAA Licensing Health Insurance Fraud 111

HIPAA Journal

DECEMBER 19, 2022

A review of the files on the compromised servers confirmed that protected health information such as patient names, dates of birth, Social Security numbers, driver’s license numbers, health insurance information, and diagnosis and treatment information had been exposed. The DOL and the U.S.

Fraud 107

Fraud Licensing HIPAA Health Insurance 107

The Health Law Firm Blog

MARCH 26, 2024

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D.,

Licensing 52

Licensing Nurses Fraud Medicaid 52

The Health Law Firm Blog

DECEMBER 31, 2022

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D.,

Licensing 52

Licensing Nurses Fraud Medicaid 52

HIPAA Journal

FEBRUARY 16, 2023

The Nashville, TN-based health system, Advent Health Partners, has proposed a $500,000 settlement to resolve claims related to a September 2021 data breach involving the protected health information of 61,072 patients. Advent Health Partners detected a breach of its email environment in early September 2021.

HIPAA 107

HIPAA Fraud Licensing Health Insurance 107

The Health Law Firm

FEBRUARY 14, 2022

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Doctors 52

The Health Law Firm Blog

MARCH 11, 2024

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D.,

Licensing 52

Licensing Nurses Fraud Medicaid 52

The Health Law Firm Blog

DECEMBER 16, 2022

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D.,

Licensing 52

Licensing Nurses Fraud Medicaid 52

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 95

Fraud Health Insurance Ransomware HIPAA 95

Provider Trust

APRIL 26, 2023

However, this solution comes with its share of compliance risks, especially if interstate licenses are involved. Nurse Strikes and Interim Solutions Present Licensure Challenges In 2021 and 2022, hospitals like Mount Sinai in New York and St. It’s no wonder nurse strikes have been on the rise.

Licensing 52

Licensing Nurses Compliance COVID-19 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

HIPAA Journal

MAY 25, 2022

SAC Health said it is unaware of any actual or attempted misuse of patient data as a result of the break-in; however, as a precaution against identity theft and fraud, affected individuals have been offered complimentary credit monitoring services. Notification letters were sent to those individuals on May 3, 2022.

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Ransomware Fraud HIPAA Licensing 137

Provider Trust

MARCH 13, 2023

Between 2016 and 2021, over 7,600 fake diplomas were sold to nursing students who used the fraudulent degrees to qualify for the National Council Licensure Exam (NCLEX). State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment.

Fraud 52

Fraud US Department of Health and Human Services Licensing Nurses 52

HIPAA Journal

SEPTEMBER 12, 2023

Seymour, IN-based Schneck Medical Center has settled a lawsuit with the Indiana attorney general, Todd Rokita, over a 2021 ransomware attack and data breach that affected 89,707 Indiana residents.

HIPAA 103

HIPAA Ransomware Health Insurance Fraud 103

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors?

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

HIPAA Journal

DECEMBER 7, 2022

Urology of Greater Atlanta Notifies Almost 80,000 Patients About August 2021 Data Breach. Urology of Greater Atlanta has now confirmed that it was the victim of a cyberattack that was detected on August 29, 2021. In some cases, Social Security numbers, driver’s license numbers, or financial account information, were also exposed.

COVID-19 Vaccine 103

COVID-19 Vaccine COVID-19 Department of Veterans Affairs Licensing 103

HIT Consultant

DECEMBER 10, 2021

Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know. What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Report Background.

COVID-19 98

COVID-19 Fraud Nurses Licensing 98

Healthcare Compliance Blog

MARCH 10, 2022

Complaints of resident abuse in a Michigan nursing home led to an investigation by the Michigan Office of Attorney General’s Health Care Fraud Division, working with the Michigan Sentinel Project. The investigation determined that a nurse was working at the nursing home while her license was suspended, which is a felony.

Nursing Homes 59

Nursing Homes Nurses Licensing Fraud 59

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

Nurses 52

Nurses Licensing Fraud Medicaid 52

Med-Net Compliance

SEPTEMBER 14, 2022

A Massachusetts home health aide, who was licensed as a Certified Nursing Assistant (CNA), has been indicted in connection with a home surveillance video showing her abusing an elderly patient, Attorney General Maura Healey announced. The aide was indicted by a grand jury on two charges of assault and battery on an elder by a caretaker.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Medicaid Medicaid 59

HIPAA Journal

JANUARY 27, 2023

The forensic investigation and document review concluded on December 28, 2022, and confirmed that the attackers had access to its network between December 31, 2021, and January 27, 2022, and may have viewed or obtained files that contained protected health information.

Ransomware 107

Ransomware HIPAA Fraud Licensing 107

Med-Net Compliance

SEPTEMBER 7, 2022

A 49-year-old Texas physician assistant was arrested and charged for his role in a scheme to defraud Medicaid by working with a suspended medical license. On July 20, 2021, the Texas Medical Board allegedly ordered the immediate suspension of his physician assistant license, deeming him to be a “continuing threat to public welfare.”

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Medicaid Medicaid Licensing Medical Personnel 59

The Health Law Firm Blog

MAY 12, 2023

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By George F. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her [.]

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

The Health Law Firm Blog

FEBRUARY 15, 2022

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By George F. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her.

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

Innovaare Compliance

FEBRUARY 9, 2021

New CMS star ratings criteria 2021. With the CMS release of the Final Rule for Contract Year 2021 on May 22, 2020, Medicare Advantage (MA) plans now have some near-term clarity regarding the many star-rating proposals made earlier this year. Read More – Medicare Star Ratings Changes 2021 . Industry trends. CMS Newsroom.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIPAA Journal

SEPTEMBER 28, 2022

Wolfe Clinic used the myCare Integrity medical records platform, which was accessed by an unauthorized party on or around December 4, 2021, who deleted databases and system configuration files. The attack exposed the protected health information of 542,776 current and former Wolfe Clinic patients. million patients.

Electronic Medical Records 75

Electronic Medical Records Ransomware Fraud HIPAA 75

HIPAA Journal

NOVEMBER 21, 2022

The Wisconsin-based dermatology practice, Forefront Dermatology, has agreed to settle a class action lawsuit filed on behalf of patients whose protected health information (PHI) was compromised in a ransomware attack in late May 2021. Forefront Dermatology has affiliated practices in 21 states and Washington D.C.

Ransomware 64

Ransomware Fraud HIPAA Licensing 64

HIPAA Journal

DECEMBER 23, 2022

Affected providers started to be notified in March that hackers had gained access to its databases in December 2021. The databases contained extensive patient information, such as contact information, health insurance information, medical record numbers, Social Security numbers, driver’s license numbers, and medical information.

HIPAA 105

HIPAA Ransomware Health Insurance Compliance 105

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Healthcare Compliance Blog

JANUARY 17, 2022

The indictment alleges that in August 2021 she tampered with the liquid morphine with reckless disregard and extreme indifference for the risk that the patients would be placed in danger of bodily injury. The nurse was aware that the diluted substance would be dispensed to the patients. Drug diversion is a growing problem in healthcare.

Nurses 59

Nurses Fraud Licensing Governance 59

Verisys

JUNE 8, 2023

Without technology automation, on average, it takes two to four months to complete the credentialing and enrollment for a newly hired licensed medical professional. Fraud Data Gap The U.S. trillion in 2021, making it highly susceptible to fraud. Let’s take a look at two areas where data gaps commonly occur.

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Compliance Fraud Licensing Medicare 52